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psychologists and brain scientists now routinely speak of androgenization (or masculinization) of the brain.
    Does this prove beyond a doubt that the Ahs and Andras had their brains and behavior masculinized by exposure to androgens or similar hormones? No. Does it, combined with much other evidence, strongly suggest that this is what happened? Yes, but that’s not all.
    It’s not only XX individuals who can be born with undefined genitals. XYs can be too, or at least with very underdeveloped male genitals, among other anatomical problems. One such condition is called cloacal exstrophy, a complex diversion of developing anatomy. Today, techniques of surgical reconstruction allow almost all XY babies with this condition—suppose we call them “Clokes”—to be assigned as male and have penises with at least some functionality. But this was not the case in the past, and so, as was true of Ahs and Andras, Clokes were often assigned to be female and had surgery and hormone treatments accordingly.
    Eventually their gender psychology was explored. In a 2004 study by William Reiner and John Gearhart of sixteen of them, aged between eight and twenty-one, two had been labeled male at birth and remained male by all psychological measures. The other fourteen had been assigned to grow up as female and raised as such. But in the 2004 follow-up, eight of the fourteen expressed a desire to be male, nine had mainly male friends, ten had typically male levels of rough-and-tumble play, and all fourteen preferred typically male toys and games. It’s important that six remained content with their female gender identity, but the weight of evidence pointed to a significant role for prenatal androgens.
    That same year, Reiner published a longer paper with a larger series of patients and more details. Here is an exchange with a thirteen-year-old who had been told eight months earlier the truth about his condition of birth, diagnosis, and early treatment:
    Q: How long did it take you when your mom and dad actually told you . . . how long did it take you to realize that they were telling you the truth and all of that kind of stuff?
    BJ: Right when they told me, because now everything made sense.
    BJ took a boy’s name, tore the flowers off the wall in his pink room, and had his mom repaint it. He stayed out of school for a week and sometimes felt sad, mainly because he was worried about his friends’ reactions. According to Reiner, the parents of these kids were often in turmoil, yet they reported that “at times the children seemed to be almost empowered by their declaration” and the interview with BJ about his transition experience “demonstrates a scenario that is typical of many of these children.”
    Reiner does not suggest that these children, now boys, have an easy future ahead, but he stresses that surgical correction to female anatomy and rearing as girls was a mistake for many of them. Their parents reported good social functioning. Six had at some point spontaneously declared their status as changed to male; seven others had made the transition decisively after their parents decided to inform them, at various times in their development, about their early condition. The transition was typically easier for the child than for the parents. Reiner (whose follow-up team preserved whatever information or secrecy the family had previously established) concludes movingly, “These children adapt to their lives with severe somatic anomalies, pathophysiologic vulnerabilities, and complex medical and surgical interventions from birth. They do not observe their lives; they live their lives.” He also says that the research implies “an important role for prenatal androgen exposure in male-typical development, including male sexual identity. Clinical algorithms and paradigms in these children need to be re-evaluated.”
    This is equally true of XY babies born without a penis or who lost a penis through a botched circumcision, infection, dog